Department of Internal Medicine, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, Bucharest, 020125, Romania.
BMC Gastroenterol. 2012 Jul 9;12:86. doi: 10.1186/1471-230X-12-86.
A tenth of patients with involuntary weight loss (IWL) have gastrointestinal cancer. Ferritin is the first parameter to be modified during the process leading to iron deficiency anaemia, therefore it should be the most sensitive. The aim of this study was to assess the ability of ferritin to rule out gastrointestinal cancer in patients with involuntary weight loss.
All consecutive patients with IWL admitted in a secondary care university hospital were prospectively studied. Ferritin, haemoglobin with erythrocyte indices and serum iron were recorded for all patients. The reference standard was bidirectional endoscopy and/or 6 months follow-up.
290 patients were included, a quarter had cancer, of which 22 (7.6%) had gastrointestinal cancer (8 gastric cancer, 1 ileum cancer, 13 colorectal cancer). Ferritin had the best area under the curve (AUC), both for gastrointestinal cancer (0.746, CI: 0.691-0.794), and colorectal cancer (0.765, CI: 0.713-0.813), compared to the other parameters of iron deficiency. In the diagnosis of colorectal cancer, ferritin with a cut-off value of 100 mcg/L had a sensitivity of 93% (CI: 69-100%), and negative likelihood ratio of 0.13, with a negative predictive value of 99% (96-100%), while for gastrointestinal cancer, the sensitivity was lower (89%, CI: 67-95%), with a negative likelihood ratio of 0.24. There were three false negative patients, two with gastric cancer, and one with rectal cancer.
In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.
十分之一的非自愿性体重减轻（IWL）患者患有胃肠道癌症。铁蛋白是导致缺铁性贫血过程中首先改变的参数，因此它应该是最敏感的。本研究旨在评估铁蛋白在非自愿性体重减轻患者中排除胃肠道癌的能力。
所有因 IWL 而被收入二级保健大学医院的连续患者均进行前瞻性研究。所有患者均记录铁蛋白、血红蛋白和红细胞指数以及血清铁。参考标准是双向内窥镜检查和/或 6 个月随访。
共纳入 290 例患者，其中四分之一患有癌症，其中 22 例（7.6%）患有胃肠道癌（8 例胃癌、1 例回肠癌、13 例结直肠癌）。铁蛋白的曲线下面积（AUC）最佳，无论是针对胃肠道癌（0.746，CI：0.691-0.794），还是针对结直肠癌（0.765，CI：0.713-0.813），均优于其他缺铁参数。在结直肠癌的诊断中，铁蛋白的截断值为 100 mcg/L 时，敏感性为 93%（CI：69-100%），阴性似然比为 0.13，阴性预测值为 99%（96-100%），而对于胃肠道癌症，敏感性较低（89%，CI：67-95%），阴性似然比为 0.24。有 3 例假阴性患者，其中 2 例为胃癌，1 例为直肠癌。
在非自愿性体重减轻的患者中，铁蛋白高于 100mcg/L 可排除结肠癌，但不能排除胃癌或直肠癌。
